POS0300 FACTORS ASSOCIATED WITH SECUKINUMAB (SEC) RETENTION IN AXIAL SPONDYLOARTHRITIS (axSpA): RESULTS OF THE FRENCH RETROSPECTIVE STUDY FORSYA
Authors: M. Dougados, J. Lucas, E. Desfleurs, P. Claudepierre, P. Goupille, A. Ruyssen-Witrand, A. Saraux, A. Tournadre, D. Wendling, C. Lukas
Journal: Annals of the Rheumatic Diseases (2022)

Background While data on real-life SEC retention rate in patients (pts) with axSpA is accumulating, there are no data on predictive factors for this retention. Presence of objective sign of inflammation (OSI) are known to be predictive of efficacy of anti-TNFs and their retention in axSpA. Objectives To assess whether OSI were predictive of SEC retention at 1 year in axSpA. Methods French retrospective study collecting between October 2019 and September 2020 data from axSpA pts a) having initiated and received at least one dose of SEC between August 11 th 2016 and August 31 st 2018, b)with at least a one year follow-up period. Retention of SEC at 1 year was estimated by the Kaplan Meier (KM) method. OSI were defined by at least one of the following: CRP&gt; N, MRI-inflammation at the sacroiliac or spine level. Preselected factors of SEC retention at 1 year (≥1 OSI, age, sex, BMI, smoking, HLA B27, non-radiographic vs radiographic axSpA, past or present uveitis / Inflammatory Bowel Disease (IBD) / psoriasis / arthritis or synovitis, diagnostic delay, disease duration, SEC line of biologic therapy, SEC maintenance dose, concomitant csDMARD / oral corticosteroids / proton pomp inhibitor, history of depression / fibromyalgia) were analyzed by multivariate cox model regression. Only variables with &lt;20% missing data were included in the model after imputation and stepwise selection (significance level for entering variables = 20%; for removing variables = 10%). OSI was forced into the model whatever its significance level or rate of missing data. Results In total, 906 pts from 47 centers (male: 42.2%, mean age: 46.2 ± 11.7 years, mean disease duration: 9,3 ± 9.1 years), were included in the analysis. At initiation of SEC, 86.3% of pts had ≥ 1 OSI and respectively 8.0%, 14.9% and 77.1% were in 1 st , 2 nd and ≥ 3 rd line (L) of biologic/targeted synthetic DMARD. The 1 year KM survival rate for SEC was 59% [95%CI:55%-62%] overall, 58% [54%-62%] and 63% [53%-73%] for pts with or without OSI, and was numerically greater in 1 st L vs 2 nd and ≥3 rd L (70% [59%-81%], 62% [54%-70%], 57% [53%-61%] respectively). In multivariate analysis absence of OSI, lack of prior exposure to anti-TNF inhibitors, absence of IBD, and absence of history of depression were associated with a better SEC retention at 1 year (Table 1). Table 1. Predictive factors of SEC 1 year retention identified by multivariate cox regression analysis (multiple imputation + stepwise selection) Predictive factors (* reference) Still on SEC at 1 Year (%)# HR [95% CI] p vs ref p type III ≥ 1 objective sign of inflammation No (N=165)* 65.3% yes (N=711) 58.8% 1.44 [1.08; 1.93] 0.014 SEC treatment line 1 st L (N=68)* 72.2% 0.084 2 nd L (N=132) 62.7% 1.53 [0.91; 2.57] 0.107 ≥ 3 rd L (N=676) 57.6% 1.67 [1.06; 2.62] 0.028 Past or present history of IBD No (N=854)* 59.8% Yes (N=22) 40.9% 1.76 [1.01; 3.07] 0.047 History of depression or anti-depressive concomitant treatment No (N=716)* 60.8% Yes (N=160) 54.5% 1.25 [0.97; 1.60] 0.090 # without imputation for missing data Interpretation HR &gt; 1: the hazard of discontinuation at 1 year is X times higher vs reference Conclusion The overall retention of SEC at 1 year in daily practice at the time of its launch in France was 59% for axSpA patients and OSI, prior exposure to TNF inhibitors, IBD and history of depression were identified as predictive factors of SEC retention. Acknowledgements Authors thank the participating investigators, centers and patients. NOVARTIS Pharma France financially supported this study. Disclosure of Interests Maxime Dougados Consultant of: Honorarium from Novartis Pharma France, Julien Lucas: None declared, Emilie Desfleurs Employee of: Novartis employee, Pascal Claudepierre Consultant of: Honorarium from Novartis Pharma France, Philippe Goupille Consultant of: Honorarium from Novartis Pharma France, Adeline Ruyssen-Witrand Consultant of: Honorarium from Novartis Pharma France, Alain Saraux Consultant of: Honorarium from Novartis Pharma France, Anne Tournadre Speakers bureau: AbbVie, Fresenius-Kabi, Janssen, Lilly, MSD, Novartis, Pfizer, Roche-Chugai, Sanofi, Consultant of: AbbVie, Fresenius-Kabi, Janssen, Lilly, MSD, Novartis, Pfizer, Roche-Chugai, Sanofi, Grant/research support from: AbbVie, Fresenius-Kabi, Janssen, Lilly, MSD, Novartis, Pfizer, Roche-Chugai, Sanofi, Daniel Wendling Consultant of: Honorarium from Novartis Pharma France, Cédric Lukas Consultant of: Honorarium from Novartis Pharma France